Congress extends telehealth coverage for 151 days after PHE; Patients can be at home | Healthcare Compliance Association (HCCA)

Medicare Compliance Report 31, no. 9 (March 14, 2022)

Congress breathed new life into telehealth services, at least for five months after the end of the public health emergency (PHE) COVID-19, in the $1.5 trillion bill that funds the government federal government until September and is sending emergency aid to Ukraine.[1] The bill extends Medicare coverage to telehealth services delivered to patients’ homes, audio-only telehealth services, and other flexibilities that are products of the PHE and its waivers. It was passed by the House on March 9 and the Senate on March 10 and is expected to be signed quickly by President Joe Biden.

“It’s a huge ‘we love telehealth’ vote,” said Allison Kassir, senior government relations adviser at King & Spalding in Washington, DC. Without this measure in the Consolidated Appropriations Act (CAA) of 2022, providers and patients suffered a stark loss. of broad Medicare coverage for telehealth services at the end of the PHE, which could be as early as mid-April or possibly mid-July, depending on whether the improving picture of COVID-19 continues darkens again. “It’s a steep cliff,” Kassir noted. “Unless you legislate it, there is no phasing out.”

The CAA’s telehealth provisions guarantee Medicare coverage of basic flexibilities for 151 days beginning on the first day after PHE ends, Kassir said. “There’s such bipartisan support for this,” and in recent years that’s a rare thing, she noted. But telehealth “has been demystified”. The two-year COVID-19 exemption from certain Medicare telehealth requirements “has been such a good test of this means of care delivery.” The CAA provisions also set the stage for a stand-alone bill that could permanently expand telehealth services, although it is expected to include “safeguards” and other integrity measures. of the program, Kassir said.

Congress has covered a lot of telehealth ground. “The majority of PHE flexibilities are captured in this legislative extension,” said Richelle Marting, an attorney in Olathe, Kansas. Perhaps the broadest trait is the bill’s definition of “originating site” to refer to any site where a “telehealth-eligible person” is located when the services are provided. Prior to the PHE, the home-site requirement generally limited Medicare coverage to services provided to patients in hospitals and other delivery locations (not in patients’ homes) by practitioners at remote sites (e.g., doctors). The COVID-19 waivers set aside the site-of-origin requirement for telehealth services, allowing them to be provided in patients’ homes, and the legislation would maintain this flexibility 151 days after the end of the PHE. Marting said this appears to be even broader than the waivers, allowing Medicare coverage of telehealth services provided wherever the patient is located (e.g., coffee shop, patient’s car, library), resolving the concerns of many providers as to whether these locations qualify as “domiciled” under the current PHE waivers.

But the legislation does not specifically authorize Medicare to pay the originating site fee for any new originating site location covered by the legislation. She explained that Congress authorized the continuation for five months of payments to remote site practitioners for telehealth services provided to patients in their homes and other locations that are not the usual pre-PHE origin sites. , but “locations that were not statutorily identified as Originating Sites prior to the PHE cannot charge an Originating Site Fee if they only qualify as Originating Sites after of this new legislative extension. For example, “if there is a retail clinic or pharmacy, the patient could be at those locations and still receive telehealth service, and the remote site professional may charge for it, but the clinic or retail pharmacy could not charge an origin site fee,” Marting said. “The difference is that before COVID, the entire telehealth service was not allowed if the patient was not at an eligible source site.”

[View source.]

Comments are closed.